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Abstract

Service intensity can vary dramatically across the clients who are served within a psychosocial intervention. But studies of the determinants of intensity are disappointing, and examinations of its impacts on key client behaviors tend to be biased by unaccounted for reciprocal relations. The author argues that it may be useful to take into account organizational attributes. Service intensity may be more fully explained by attributes such as program life-cycles and learning routines, administrative reforms, worker attention spans, worker dispositions, and caseloads. Data from an intervention for adults with homeless experience and substance abuse problems (n=136) support the author's argument. Results suggest that intervention leaders must become aware of and capable of manipulating the organizational context of treatment.

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REFERENCES

  • Bahr, H.M., & Caplow, T. (1974). Old men drunk and sober. New York: New York University Press.

    Google Scholar 

  • Baker, S.G. (1994). Gender, ethnicity, and homelessness: Accounting for demographic diversity on the streets. American Behavioral Scientist, 37(4), 476-504.

    Google Scholar 

  • Barrow, S.M., Hellman, F., Lovell, A.M., Plapinger, J.D., Robinson, D.R., & Streuning, E.L. (1985). Personal History Form. New York: New York State Psychiatric Institute, Community Support Systems Evaluation Program, Epidemiology of Mental Disorders Research Department.

  • Blau, P. (1955). The dynamics of bureaucracy. Chicago: University of Chicago Press.

    Google Scholar 

  • Bollen, K.A. (1989). Structural equations with latent variables. New York: John Wiley & Sons.

    Google Scholar 

  • Bond, G.R., Miller, L.D., Krumwied, R.D., & Ward, R.S. (1988). Assertive case management in three CMHCs: A controlled study. Hospital and Community Psychiatry, 39(4), 411-418.

    Google Scholar 

  • Brekke, J.S. (1987). The model guided method for monitoring program implementation. Evaluation Review, 11, 281-289.

    Google Scholar 

  • Brekke, J.S., Ansel, M., Long, J., Slade, E., & Weinstein, M. (1999). Intensity and continuity of services and functional outcomes in the rehabilitation of persons with schizophrenia. Psychiatric Services, 50(2), 248-257.

    Google Scholar 

  • Brekke, J.S., Long, J., & Sobel, E. (1997). The impact of service characteristics on functional outcomes from community support programs for persons with schizophrenia: A growth curve analysis. Journal of Consulting and Clinical Psychology, 65, 464-475.

    Google Scholar 

  • Brekke, J.S., & Test, M.A. (1992). A model for measuring the implementation of community support programs: Results from three sites. Community Mental Health Journal, 28(3), 227-247.

    Google Scholar 

  • Bruni, M. (1997). Dropping out of treatment among the homeless. Unpublished doctoral dissertation. The School of Social Service Administration, The University of Chicago.

  • Burt, M.R. & Cohen, B.E. (1989). America's homeless: Numbers, characteristics and programs that serve them. Washington, DC: Urban Institute Press.

  • Chisholm, S.M., Crouther, J.H., & Ben-Borath, B. (1997). Selected MMPI-2 scales' ability to predict premature termination from psychotherapy. Journal of Personality Assessment, 69(1), 124-144.

    Google Scholar 

  • Cicourel, A. & Kitsuse, J. (1963). The educational decision-makers. Indianapolis: Bobbs-Merrill.

  • D'Aunno, T., & Vaughn, T.E. (1995). An organizational analysis of service patterns in outpatient drug abuse treatment units. Journal of Substance Abuse, 7, 27-42.

    Google Scholar 

  • Dean, D.G. (1961). Alienation: Its meaning and measurement. American Sociological Review, 26, 753-758.

    Google Scholar 

  • Drake, R.E., McHugo, G.J., & Biesanz, J. (1995). The test-retest reliability of standardized instruments among homeless persons with substance use disorders. Journal of Studies of Alcohol 56, 161-167.

    Google Scholar 

  • Emerson, R.M. (1969). Judging delinquents. Chicago: Aldine.

    Google Scholar 

  • Empey, L., & Erickson, M. (1972). The Provo experiment. Lexington, MA: Lexington Press.

    Google Scholar 

  • Fischer, P.J. (1989). Estimating the prevalence of alcohol, drug, and mental health problems in the contemporary homeless population: A review of the literature. Contemporary Drug Problems, 16, 333-390.

    Google Scholar 

  • Fischer, P.J., & Breakey, W.R. (1991). The epidemiology of alcohol, drug, and mental disorders among homeless persons. American Psychologist, 46(11), 1115-1128.

    Google Scholar 

  • Fisher, G., Landis, D., & Clark, K. (1988). Case management service provision and client change.Community Mental Health Journal, 24(2), 134-142.

    Google Scholar 

  • Gade, P.A., Lakhani, H., & Kimmel, M. (1991). Military service: A good place to start? Military Psychology, 3(4), 251-267.

    Google Scholar 

  • Garfield, S.L. (1990). Issues and methods in psychotherapy process research, Journal of Consulting and Clinical Psychology, 58(3), 273-280.

    Google Scholar 

  • Greene, W.H. (1997). Econometric analysis (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Greenley, J.R., & Kirk, S.A. (1973). Organizational characteristics of agencies and the distribution of services to applicants. Journal of Health and Social Behavior, 14, 70-79.

    Google Scholar 

  • Greiner, L.E. (1972). Evolution and revolution as organizations grow. Harvard Business Review, 50, 37-46.

    Google Scholar 

  • Grella, C. (1993). A residential recovery program for homeless alcoholics: Differences in program recruitment and retention. The Journal of Mental Health Administration, 20(2), 90-99.

    Google Scholar 

  • Grigsby, C., Baumann, D., Gregorich, S.E., & Roberts-Gray, C. (1990). Disaffiliation to entrenchment: A model for understanding homelessness. Journal of Social Issues, 46(4), 141-156.

    Google Scholar 

  • Hall, R.H. (1995). Organizations: Structures, processes, and outcomes (5th ed.). Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Hambrick, D.C., & D'Aveni, R.A. (1988). Large corporate failures as downward spirals. Administrative Science Quarterly, 33, 1-23.

    Google Scholar 

  • Hargreaves, W.A., Shaw, R.E., Shadoan, R., Walker, E., Surber, R., & Gaynor, J. (1984). Measuring case management activity. The Journal of Nervous and Mental Disease, 172(5), 296-300.

    Google Scholar 

  • Harkavy, O., & Bond, J.T. (1992). Program operations: Time allocation and cost analysis. In M. Lerner, R. Halpern & O. Harkavy (Eds.), Fair start for children: Lessons learned from service demonstration projects (pp. 191-217). New Haven: Yale University Press.

    Google Scholar 

  • Hasenfeld, H. (1983). Human service organizations. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Hromco, J., Lyons, J.S., & Nikkel, R.E. (1997). Styles of case management: The philosophy and practice of case managers. Community Mental Health Journal, 33, 415-428.

    Google Scholar 

  • Jerrell, J.M., & Jerrell, S.L. (1987). Selecting the proper case management strategy. Community Mental Health Journal, 23(1), 19-29.

    Google Scholar 

  • Jerrell, J.M., & Ridgely, M.S. (1999). Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs. Psychiatric Services, 50, 109-112.

    Google Scholar 

  • Joe, G.W., Simpson, D.D., & Hubbard, R.L. (1991). Unmet service needs in methadone maintenance. International Journal of Addictions, 2(1), 1-22.

    Google Scholar 

  • Kaufman, H. (1971). The limits of organizational change. University City: University of Alabama Press.

    Google Scholar 

  • Kietze, L.L., & Bond, G.R. (1993). Relationship between case manager contact and outcome for frequently hospitalized psychiatric clients. Hospital and Community Psychiatry, 44(9), 839-843.

    Google Scholar 

  • Kimberly, J.R., & Miles, R.H. (1980). The organizational life cycle. San Francisco: Jossey-Bass.

    Google Scholar 

  • Kimberly, J.R., & Quinn, R.E. (1984). The challenge of transition management. In J.R. Kimberly & R.E. Quinn (Eds.), Managing organizational transitions. Homewood, IL: Richard D. Irwin.

    Google Scholar 

  • Levitt, B., & March, J.G. (1988). Organizational learning. Annual Review of Sociology, 14, 319-340.

    Google Scholar 

  • Lipsky, M. (1980). Street-level bureaucracy. New York: Sage.

    Google Scholar 

  • Maddala, G.S. (1983). Limited-dependent and qualitative variables in econometrics. Cambridge: Cambridge University Press.

    Google Scholar 

  • Marlatt, G.A., & Gordon, J.R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.

    Google Scholar 

  • McGrew, J., & Bond, G.R. (1997). The association between program characteristics and service treatment in assertive community treatment. Administration and Policy in Mental Health, 25(2), 175-198.

    Google Scholar 

  • McGrew, J.H., Bond, G.R., Dietzen, L., & Salyers, M. (1993). Measuring the fidelity of a mental health program model (mimeo). Indiana University-Purdue University at Indianapolis.

  • McLellan, A.T., Luborsky, L., Woody, G.E., & O'Brien, C.P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disorders, 168, 26-33.

    Google Scholar 

  • Meichenbaum, D., & Turk, D.C. (1987). Facilitating treatment adherence. New York: Plenum.

    Google Scholar 

  • Merton, R. (1957). Social theory and social structure. Glencoe, IL: Free Press.

    Google Scholar 

  • Milner, M. (1980). Unequal care: A case study of interorganizational relations in health care. New York: Columbia University Press.

    Google Scholar 

  • Mintzberg, H. (1986). Crafting strategy. Harvard Business Review, 4, 66-75.

    Google Scholar 

  • Momeni, J.A. (1990). No place to go: A national picture of homelessness in America. In J.A. Momeni (Ed.), Homelessness in the United States, Volume II: Data and Issues. New York: Greenwood Press.

    Google Scholar 

  • Moncher, F.J., & Prinz, R.J. (1991). Treatment fidelity in outcome studies. Clinical Psychology Review, 11(3), 247-266.

    Google Scholar 

  • Moos, R.H., Finney, J.W., & Cronkite, R.C. (1990). Alcoholism treatment: Context, process, and outcome. New York: Oxford University Press.

    Google Scholar 

  • Morgan, G. (1997). Images of organization. Beverly Hills, CA: Sage.

    Google Scholar 

  • Orwin, R.G., Sonnefelt, L.J., Garrison-Mogren, R., & Smith, N.G. (1994). Pitfalls in evaluating the effectiveness of case management programs for homeless persons: Lessons from the NIAAA Community Demonstration Program. Evaluation Review, 18(2), 153-207.

    Google Scholar 

  • Owen, W. (1984). Analysis and aggregation of CMHC outcome data in a statewide evaluation system: A case report. Community Mental Health Journal, 20, 27-43.

    Google Scholar 

  • Palmer, J.A., Palmer, L.K., & Williamson, D. (1995). Childhood abuse as a factor in attrition from drug rehabilitation. Psychological Reports, 73(3), 879-882.

    Google Scholar 

  • Perrow, C. (1986). Complex organizations: A critical essay. New York: Random House.

    Google Scholar 

  • Pfeffer, J. (1992). Managing with power: Politics and influence in organizations. Boston: Harvard Business School Press.

    Google Scholar 

  • Pfeffer, J., & Salancik, G. (1978). The external control of organizations. New York: Harper & Row.

    Google Scholar 

  • Pressman, J., & Wildavsky, A. (1973). Implementation. Berkeley: University of California Press.

    Google Scholar 

  • Prottas, J. (1979). People processing. Lexington, MA: D.C. Heath.

    Google Scholar 

  • Rapp, C.A. (1998). The active ingredients of effective case management: A research synthesis. Community Mental Health Journal, 34, 363-380.

    Google Scholar 

  • Rees, D.W. (1985). Health beliefs and compliance with alcoholism treatment. Journal of Studies on Alcohol, 46, 517-524.

    Google Scholar 

  • Rife, J.C., First, R.J., Greenlee, R.W., Miller, L.D., & Feichter, M.A., 1991. Case management with homeless mentally ill people. Health and Social Work, 16(1), 58-67.

    Google Scholar 

  • Rosenbaum, P.R., & Rubin, D.B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41-55.

    Google Scholar 

  • Rossi, P. (1989). Down and out in America. Chicago: University of Chicago Press.

    Google Scholar 

  • Roth, D., Bean, J., Lust, N., & Saveanu, T. (1985). Homelessness in Ohio: A study of people in need. Ohio Department of Mental Health, Office of Program Education and Research.

  • Roth, J. (1972). Some contingencies of the moral evaluation and control of clientele: The case of the hospital emergency room. American Journal of Sociology, 77, 839-856.

    Google Scholar 

  • Sandell, R., & Bentling, U. (1996). Treatment utilization and personality organization among drug abusers in Sweden. Journal of Substance Abuse Treatment, 13(3), 257-263.

    Google Scholar 

  • Schmidt-Poster, J., & Jerrell, J.M. (1998). Qualitative analysis of three case management programs. Community Mental Health Journal, 34, 381-392.

    Google Scholar 

  • Scott, W.R. (1992). Organizations: Rational, natural and open systems (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Shaw, R.E., Hargreaves, W.I., Surber, R., Luft, L., & Shadoan, R. (1990). Continuity and intensity of case management activity in three CMHCs. Hospital and Community Psychiatry, 41, 323-326.

    Google Scholar 

  • Simpson, D.D., Joe, G.W., Rowan-Szal, G.A., & Greener, J.M. (1997). Drug abuse treatment process components that improve retention. Journal of Substance Abuse Treatment, 14, 565-572.

    Google Scholar 

  • Snowden, L.R., & Clancey, T. (1990). Service intensity and client improvement at a predominantly black community mental health center. Economic and Program Planning, 13(3), 205-210.

    Google Scholar 

  • Sosin, M.R. (1978). Due process mandates and the operation of juvenile courts. Social Service Research, 1, 4.

    Google Scholar 

  • Sosin, M.R., & Bruni, M. (in press). Personal and situational perspectives on rejection in a homelessness and substance abuse program: An exploratory study. Social Work Research.

  • Sosin, M.R., Bruni, M., & Reidy, M. (1995). Paths and impacts in the progressive independence model: A homelessness and substance abuse intervention in Chicago. Journal of Addictive Diseases, 14(4), 1-20.

    Google Scholar 

  • Sosin, M.R., Colson, P., & Grossman, S. (1988). Homelessness in Chicago: Social institutions and social change. The University of Chicago: The School of Social Service Administration.

  • Sosin, M.R., Schwingen, J., & Yamaguchi, J. (1993). Case management and supported housing in Chicago: The interaction of program resources and client characteristics. Alcoholism Treatment Quarterly, 10, 35-50.

    Google Scholar 

  • Sosin, M.R., & Yamaguchi, J. (1995). Case management routines and discretion in a program addressing homelessness and substance abuse. Contemporary Drug Problems MDBI, 12(2), 317-342.

    Google Scholar 

  • Sosin, M.R., Yamaguchi, J., Bruni, M., Grossman, S., Leonelli, B., & Reidy, M. (1994). Treating homelessness and substance abuse in community context: A case management and supported housing demonstration. The University of Chicago: School of Social Service Administration.

  • Standard, R. (1999). The effect of training in a strengths model of case management on client outcomes in a community mental health center. Community Mental Health Journal, 35, 169-179.

    Google Scholar 

  • Sudnow, D. (1965). Normal crimes: Sociological features of the Penal Code in a public defender's office. Social Problems, 12, 255-276.

    Google Scholar 

  • Susser, E., Lin, S.P., Conover, S., & Streuning, E.L. (1991). Childhood antecedents of homelessness in psychiatric patients. American Journal of Psychiatry, 148(8), 1026-1030.

    Google Scholar 

  • Tushman, M., & Anderson, P. (1986). Technological discontinuities and organizational environments. Administrative Science Quarterly, 31, 439-465.

    Google Scholar 

  • Wallace, S.E. (1965). Skid row as a way of life. Totowa, NJ: Bedminister Press.

    Google Scholar 

  • Williams, M.L., Forster, P., McCarthy, G.D., & Hargreaves, W.A. (1994). Managing case management: What makes it work? Psychosocial Rehabilitation Journal, 18, 49-59.

    Google Scholar 

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Sosin, M.R. Service Intensity and Organizational Attributes: A Preliminary Inquiry. Adm Policy Ment Health 28, 371–392 (2001). https://doi.org/10.1023/A:1011165916669

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